For years, Colorado lawmakers have worked relentlessly to reform the state’s health care system. But that work has often focused on just one narrow area: health insurance.
From expanding access to Medicaid, to setting up a state health insurance exchange, to engineering a complicated reinsurance program to creating the Colorado Option, a government-designed health plan, the brightest minds in health policy in Colorado have spent a lot of the last decade thinking about how to get more people covered at lower prices.
That focus is now starting to change, though, simply because there’s not a lot left to do on insurance, according to one of the state’s most prominent thinkers on health care and reform.
Michele Lueck has led the Colorado Health Institute, a nonpartisan think tank, for more than 11 years. In her time, she has taken CHI from a 14-person team built mostly on foundation grant money to a nearly 30-person team pulling in $6 million a year, much of that from consulting and contract research work.
But later this summer, Lueck will leave her position as president and CEO to take over at the helm of Partners for Children’s Mental Health, an organization that works with Children’s Hospital Colorado and the University of Colorado School of Medicine Department of Psychiatry to improve the youth mental health system.
Lueck recently spoke with The Colorado Sun about why she decided to make the switch, why now and where she thinks health care policy in the state is heading. The following Q&A has been condensed and edited for clarity and brevity.
The Colorado Sun: As the crisis phase of the COVID pandemic ends, we’re seeing a lot of people in the health world leaving their jobs or changing roles. Did that play into your decision?
Michele Lueck: We’re after the really, really acute part of all the clinical challenges and the high mortality rates of the pandemic. But what’s being revealed is sort of cascading and rippling other pandemics, and I would put youth mental health as one of those subsequent pandemics, that was there before, but was revealed by the pandemic. We’re just at the advent of understanding the particular consequences of a pandemic.
Being the leader of a nonprofit organization during COVID, has been challenging. And I think there are a number of people who have shared that with me. And so, you know, maybe we call it a coincidence. But it’s been a hard run, I think, for many of us.
Sun: How has the state’s focus on health and health care shifted during your years at CHI?
Lueck: The decade that I sort of wrapped up was one that was focused on access and insurance. Those were sort of the policy goals and outcomes that were most important to the state of Colorado and therefore to CHI.
As I look at the 10 or so years that I’ve been at the helm of CHI, I think there were also policy goals that were broader than just access and insurance. There was sort of this recognition over time that the things that matter most to health outcomes are not found within the health care system. They’re found outside or adjacent to that. They’re found in things like food access and in access or the availability of good jobs and living wages and in housing and in education and transportation.
Sun: Do you think that means we’ll now see less focus on technical fixes to the system and more work on the root causes of some of these health problems?
Lueck: I think the market, if you can call it that, has shifted away. We’ve had this radical decline in our uninsured rate. We’ve gone from 17% a decade ago to somewhere around 6, 6-and-a-half percent of Coloradans not having access to insurance. We think we’re pretty close to having maxed out the number of people who have insurance. We have to be vigilant about it. But we have the levers; we have the opportunities for people to gain health insurance.
So I think with the implementation of that, we’ve been able to focus some of our energy on these more structural and systemic issues. You know, we see a lot of focus on health equity and racial justice within our health systems. We’re thinking very upstream about prevention. And I think it’s appropriate.
Sun: As the state starts to look into these broader underlying areas affecting our health, how do you choose where to put your energy?
Lueck: Yeah, put another way, what we talked about internally is when you start talking about the social determinants of health, there’s nothing that isn’t one. But you can’t do everything.
One of the processes that CHI went through over the last year was to really focus on the question: As we look to the next 10 years of CHI’s existence, what are the top health issues that if we don’t get right in the next decade, we should close our doors and go home? We arrived at three issues that we think are paramount to the health of Coloradans in the next decade. And if we don’t get them, right, shame on us.
Those are youth and adolescent behavioral health; climate and health and helping communities mitigate and adapt to the health implications of a changing climate; and a more intense focus on the systems of care and the data that make it possible for individuals, whether they be providers or families, to access information about all those social determinants of health — how do we break down the silos?
But you’ve got to pick your lanes as nonprofits or as any kind of organization. And it also, I think, my final point would be that it really underscores the need for multi-sector and multidisciplinary approaches. We’re not going to be able to do everything. And so it highlights the importance of partnership.
Sun: You’re now moving from an organization that looks broadly at the health care system to one that focuses on just one piece of it. What are you most looking forward to in your new job?
Lueck: I’m excited about tackling one of the most urgent and emergent issues that we have as a state and that is to help to build and strengthen a behavioral health system that our kids deserve. We believe that there’s an optimal mix of programs and policies and services that allow everyone in Colorado to thrive. And working towards that goal, I can’t imagine anything more important at this point in my career.
We need to look at better policies and stronger policies, we need to look at research, we need to look at how kids live in this world that is so radically different from the one that we grew up in. And all of those things are on the table.